Benevolence Assistance Request Form

Benevolence Assistance Request Form
MonthDayYear
Date
What is the Benevolence Fund?

The Benevolence Fund is a limited financial fund, made available by application to
members of Lifeline TNT Global Ministries who are struggling financially. You must
have been a member at least 6 months and a consistent tithe payer to qualify.
Repayment is not expected. However, if you are blessed in the future and would like to help someone else, you may repay the gift. It will be used to help someone else in need.

What kind of help is available?

Assistance with utilities and rent assistance are available. In order to continue
to get support from the Benevolence Fund, adhere to any instructions given by
Benevolence decision.

Who will see the information that I put on this form?

All information provided on the Benevolence application and to the Benevolence
Team or Pastors will be kept as private as possible. Please be honest and open in
responding to the questions. It is likely during the process that your information
may be reviewed by the church staff, the Benevolence Team, Elders, and Pastors.
We are not here to judge anyone, but to provide compassionate assistance
according to our guidelines and available resources in times of difficulty.

What do I do after filling out this form?

Once an application is received, the Benevolence Team will meet to review it. You
will be contacted if more information is needed. If your request is approved, it
may take up to 2 weeks to receive funding. No funding will be given directly to
the applicant, but to the company where the amount is needed.

Criteria for considering your request:

Yes, I am a member of LifelineTNT Global Ministries.No, I am not a member of LifelineTNT Global Ministries.
If No, how did you hear about Lifeline TNT Global Ministries?
I release the LifelineTNT Global Ministries Benevolence Team to the following:(acknowledge all with your initials)

Contact my Employer and ReferencesAssess previous financial requestsContact my Life group and/or mentorRequest further supporting documentation Ministry
Personal Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Marital Status

SingleEngagedMarriedFemaleSeperatedDivorcedWidowed
Spouse Information (if applicable)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
List all Individuals sharing your household #1.

First NameLast Name
Relationship
Date of Birth

MonthDayYear
Date
Age
Monthly Income
Name #2

First NameLast Name
Relationship
Date of Birth

MonthDayYear
Date
Age
Monthly Income
Name #3

First NameLast Name
Relationship
Date

MonthDayYear
Date
Age
Monthly Income
Name #4

First NameLast Name
Relationship
Date of Birth

MonthDayYear
Date
Age
Monthly Income
Name #5

First NameLast Name
Relationship
Date of Birth

MonthDayYear
Date
Age
Monthly Income
Additional Household Members (if applicable)
Please list your specific request:
Amount Requested:
Date Funds are Needed:

MonthDayYear
Date
Briefly, what events led to your needing assistance? (Be clear and summarize your information)
Applicant Employment History:
Present/Most Recent Employer
Position & Job Description:
Name of Supervisor
Employees Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employees Phone:
Please enter a valid phone number.
Dates of Employment:
If unemployed, for how long?
Are you currently seeking employment?

YesNo
If no, why not?
If yes, what steps are you taking to seek active employment?
Spouse's Employment History:
Present/Most Recent Employer:
Position & Job Description:
Supervisor Name:

First NameLast Name
Employer's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Dates of Employment
If unemployed how long?
Are you currently seeking employment?

YesNo
If not, why not?
If yes, what steps are you taking to seek active employment?
Housing/Car:

Own/PurchasingRenting
How long at present address?
Landlord or Mortgage Company:
Landlord/Mortgage Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Landlord/Mortgage Company:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long did you live there & why did you move?
Do you have access to a car?

YesNo
If yes, please check all that apply:

Owned (paid for)Financed or LeasedBorrowedA Family Member
If owned or leased what is the Year, Make & Model of Vehicle?
If paying payments, how much until the car is paid off?
How many cars are in your household?
Additional Information:
Are you a tithe payer to TNT Global Ministries/Spirit Life Church?

YesNo
If yes, how long?
Have you seen a financial counselor in the last 6 months?

YesNo
If yes, with whom?
Have you contacted anyone else for assistance within the last six months?

YesNo
If yes, with whom?
If so, specify:

FamilyFriendsChurchesAgencies
Are any of the above assisting with your needs?

YesNo
If yes, what amount?
If no, why not?
Do you have a budget?

YesNo
Have you requested or received assistance from Lifeline TNT before?

YesNo
If so, when did you make the request and what amount was received?
Please list 3 References below:
Reference #1

First NameLast Name
Reference #1
Please enter a valid phone number.
Reference #2

First NameLast Name
Reference #2
Please enter a valid phone number.
Reference #3

First NameLast Name
Reference #3
Please enter a valid phone number.
Ministry Contact Person (if you volunteer at LifelineTNT Global Ministries)

First NameLast Name
Ministry Contact Phone Number:
Please enter a valid phone number.
Please provide any additional information, if applicable.
Financial Overview (put "N/A" if a field does not apply to you)

Please combine "ALL" Monthly Income in the fields below.
Applicant's Monthly Income
Spouse's Monthly Income
Child/Spousal Support
Retirement
Social Security
SSI/Disability
Food Stamps/WIC
Other Income
Monthly Income Incurred
Tithes/Contributions
Rent/Mortgage
Car Payment
Auto Insurance
Auto (Gas & Oil)
Electric/Gas/Water
Food (Groceries & Eating Out)
Phone (Home & Cell)
Cable TV
Day Care
Child/Spousal Support
Furniture/Appliances
Credit Card
School Loans
Bank Loans/Other
Lottery Tickets/Gambling
Personal/Pet Care
Other
Total Monthly Expenses:
Total Monthly Income:
Subtract (-) Total Monthly Expense from Total Monthly Income
What steps are you taking to improve your present situation?
Release Information

I hereby authorize the release of information to LifelineTNT Global Ministries to receive the assistance I am requesting. I further certify the information I have stated is true and correct and that all income is reported. I understand GracePoint may verify the information on this application and that deliberate misrepresentation of information may subject me to denial of assistance/services.

I give permission for LifelineTNT Global Ministries to discuss my case with other agencies,businesses, churches, attorneys, individuals, and any others deemed necessary to verify application information and/or identify additional sources of assistance. I understand that all information will remain as private as possible within these entities.

I have read, understood, and agree to the policies above regarding the Release of Information.
Signature*

Clear

Should be Empty:

Benevolence Assistance Request Form

Personal Information

Spouse Information (if applicable)

Applicant Employment History:

Spouse's Employment History:

Additional Information:

Please list 3 References below:

Financial Overview (put "N/A" if a field does not apply to you)

Monthly Income Incurred